Los Angeles County oversees the largest jail system in the world. In 2019, community organizers successfully moved the County to cancel plans to create two new jails. Instead of jail expansion, the county was compelled to create a workgroup dedicated to finding feasible and effective ways to move the County away from incarceration and towards a care-based approach to the criminal-legal process.
This Alternatives to Incarceration (ATI) workgroup, comprised of both county and community stakeholders, developed 114 recommendations for the Alternatives To Incarceration Roadmap and Final Report. The Board of Supervisors adopted 26 core foundational recommendations and 5 overarching principles. These recommendations include a racial justice analysis and range from early prevention and intervention efforts to avoid arrest and incarceration, to robust pretrial release services, as well as expanding supportive housing, services and employment for individuals returning home from incarceration.
It is now March 2022 and the tireless work of the community to reimagine what care and services can look like in our County has yet to be fully realized. Over the last several years, multiple county reports, including the Gender Responsive Advisory Committee 2021 Report and the Men’s Central Jail Closure Workgroup Report, have reaffirmed the recommendations of the ATI report and provided concrete plans for implementation and MCJ closure.
The Board of Supervisors have the roadmap, the community support and the power to move money out of bloated law enforcement budgets and into critical community-based services now. To that end, we have created an ATI Report Card to evaluate the County’s progress of decarcerating, closing Men’s Central Jail, and investing in our communities!
ISSUE: Create an independent pretrial services system within 3-6 months.
Recommendation
What's Been Done
What's Needed
Recommendation
#58: Create diversion programs to release people with mental health needs to community-based treatment as early as possible.
What's Been Done
The County has not expanded existing mental health diversion programming or created new programming.
What's Needed
The County must fund and expand the Office of Diversion and Reentry’s current bed capacity.
GRADE: F
Recommendation
What's Been Done
What's Needed
Recommendation
#56: Releasing people with support should be the default rather than money bail or jail.
What's Been Done
In 2021, the County established the Pretrial Workgroup to create a plan to comply with the Humphrey court decision and implement the pretrial recommendations of the ATI report. The workgroup developed a needs and strengths assessment that may replace the CCAT Risk Assessment Tool, but the PSA Risk Assessment Tool will remain in place. The ATI Initiative is currently in negotiations with the court on changes to the current pretrial structure. A plan has yet to be agreed upon.
What's Needed
Creating the pretrial structure that utilizes community-based services, and fully funding and implementing those services, has not been completed by the County. The LA County Superior Court remains a roadblock to releasing people without money bail or any form of incarceration, including e-carceration (i.e. electronic monitoring). The County will need either the Courts agreement to expand $0 bail and pretrial release, or state legislative changes must pass to achieve that goal. The Court’s position has been that without proper service linkage, they will not expand releases without Probation involvement.
GRADE: F+
Recommendation
What's Been Done
What's Needed
Recommendation
#55: Create an independent pretrial services entity.
What's Been Done
The Board of Supervisors passed a motion on March 1, 2022 creating a Justice, Care and Opportunities Department (JCOD), which will house pretrial services independent of Probation.
What's Needed
Funding has yet to be committed by the CEO and BOS to the JCOD, pretrial agency infrastructure, and community-based services within the new department. The Vera Institute of Justice estimates that ~$100 million per year will be needed to fully fund pretrial services, based on current pretrial population levels.
GRADE: B
Recommendation
What's Been Done
What's Needed
Recommendation
#53: Support people upon release and help them return to court if needed.
What's Been Done
The Public Defender’s Office and Alternate Public Defender’s Office have created text message reminder platforms for their clients. These platforms do not provide any service linkage and have technical limitations, relying on manual updates. The ATI Initiative has begun the development of a bed navigation platform. The details of this project have yet to be publicly available to provide a full analysis of the user capabilities and its utility in pretrial service navigation.
What's Needed
The County’s service platforms are in the initial stages and lack the cohesive, streamlined approach necessary to provide the range of return to court services needed to properly meet the needs of the pretrial population.
GRADE: D
ISSUE: Overlapping
Recommendation
What's Been Done
What's Needed
Recommendation
#58: Remove eligibility barriers and delays in connecting incarcerated people (and people in the community) to community-based treatment so people are not stuck in jail just because there is not a program.
What's Been Done
Eligibility is less an issue – except that most programs have some “charge related” barriers to entry. The MAJOR challenge continues to be that there are not nearly enough appropriate and available community treatment placements. And unfortunately, even though an individual may be released pending trial as a result of zero bail and other security mechanisms, without adequate community mental health resources, the return to jail is routine. Zero bail (which will end soon) has helped a lot of people get out that normally would not, despite the lack of a program. Some people not released on zero bail have an agreed upon release (the judge and often the prosecutor), to a program through diversion, RDP, and ODR programs. I think that the barrier to release was most improved by the emergency zero bail.
What's Needed
ATI Implementation Plan: Year 1
1a. Review criteria for admission to key levels of Mental Health care including but not limited to: Full Service Partnership (FSP), Enriched Residential Services (ERS), Outpatient, IMD, ODR Housing Program, Men’s Community Reintegration (MCRP), Women’s Community Reintegration Program (WCRP).
1b. Identify health agencies and behavioral health treatment facilities who are currently providing services to justice involved individuals and identify ways that they can expand or develop new contracts.
1c. Significantly increase funding to programs that will allow for providers to increase capacity and services.
1e. Optimize use of Medi-Cal funding and services.
1f. Determine the current population who encounters barriers to service linkage. (e.g. fire setters, people with unresolved cases, sex registrants, allegations of violence, funding exclusions, legal status, etc.), and explore existing or new resources including those that will safely serve those with high risk behaviors in the community.
1g. Expand and/or create new resources at all levels of care for people who are mentally ill or who have a co-occurring disorder, other health condition, etc.
1h. Review Data and rationale (or create a method to do so) on the average turnaround time on referrals to key levels of care.
1i. Review data on current wait times for slots, beds, and outpatient appointments. Determine which levels of care can potentially shorten turnaround times for referral/response, and placement, and update the current system.
1j. Collect data and rationale on the number of individuals who do not access treatment. Explore ways to further engage and link those who can benefit from treatment.
1k. Review and refine current clinical navigational programming pathways to treatment. Design user-friendly referral system to navigation teams.
1l. Enhance cross-communication between specialty courtrooms and county programs to allow navigation teams referral access. 1m. Create cross agency database to include outcome data to include both positive and negative outcomes, such as program completions, walk-aways, rearrests, etc.
1n. Create rapid referral and response by developing a system to look up whether or not justiceinvolved individuals have a behavioral health diagnosis or a medical diagnosis that could be causing behavioral health symptoms.
1o. Develop a 24-hour DHS/DMH/DPH hub that has an accurate and consistently updated database of providers including information about where there are beds and treatment slots available at all levels of care.
1p. Establish linkages to community based primary care to ensure continuity of care and avoid decompensation of biomedical and behavioral health.
GRADE: F
ISSUE: Mental Health Allocate $237m for 4,000 new community-based beds that drive releases.
Recommendation
What's Been Done
What's Needed
Recommendation
#02: Create places where people can immediately access trauma-informed care for people in crisis. Make sure they exist in all communities.
What's Been Done
The Department of Mental Health has added two psychiatric urgent care centers in the last two years. The County has established a number of Restorative Care Villages: MLK Medical Center Campus, LAC+USC Medical Center, Olive View-UCLA Medical Center and Rancho Los Amigos National Rehabilitation Center. A fifth Restorative Care Village is being considered for the Harbor-UCLA Medical Center. Each is supposed to have a Crisis Intervention Team available.
What's Needed
ATI Implementation Plan: Year 1
1a. Review criteria for admission to key levels of Mental Health care including but not limited to: Full Service Partnership (FSP), Enriched Residential Services (ERS), Outpatient, IMD, ODR Housing Program, Men’s Community Reintegration (MCRP), Women’s Community Reintegration Program (WCRP).
1b. Identify health agencies and behavioral health treatment facilities who are currently providing services to justice involved individuals and identify ways that they can expand or develop new contracts.
1c. Significantly increase funding to programs that will allow for providers to increase capacity and services.
1e. Optimize use of Medi-Cal funding and services.
1f. Determine the current population who encounters barriers to service linkage. (e.g. fire setters, people with unresolved cases, sex registrants, allegations of violence, funding exclusions, legal status, etc.), and explore existing or new resources including those that will safely serve those with high risk behaviors in the community.
1g. Expand and/or create new resources at all levels of care for people who are mentally ill or who have a co-occurring disorder, other health condition, etc.
1h. Review Data and rationale (or create a method to do so) on the average turnaround time on referrals to key levels of care.
1i. Review data on current wait times for slots, beds, and outpatient appointments. Determine which levels of care can potentially shorten turnaround times for referral/response, and placement, and update the current system.
1j. Collect data and rationale on the number of individuals who do not access treatment. Explore ways to further engage and link those who can benefit from treatment.
1k. Review and refine current clinical navigational programming pathways to treatment. Design user-friendly referral system to navigation teams.
1l. Enhance cross-communication between specialty courtrooms and county programs to allow navigation teams referral access. 1m. Create cross agency database to include outcome data to include both positive and negative outcomes, such as program completions, walk-aways, rearrests, etc.
1n. Create rapid referral and response by developing a system to look up whether or not justiceinvolved individuals have a behavioral health diagnosis or a medical diagnosis that could be causing behavioral health symptoms.
1o. Develop a 24-hour DHS/DMH/DPH hub that has an accurate and consistently updated database of providers including information about where there are beds and treatment slots available at all levels of care.
1p. Establish linkages to community based primary care to ensure continuity of care and avoid decompensation of biomedical and behavioral health.
GRADE: D
Recommendation
What's Been Done
What's Needed
Recommendation
#12: Diversion programs should be rooted in harm reduction.
Support and broaden implementation of community-based harm reduction strategies for individuals with mental health, substance use disorders, and/or individuals who use alcohol/drugs, including but not limited to sustained prescribing of psychiatric medications and medication assisted treatment.
What's Been Done
The Office of Diversion and Reentry’s Harm Reduction Unit has distributed 130,000 Naloxone kits since 1/20. Kits are available in jail vending machines each month and are free to people being released from jail. ODR has trained hundreds of providers in how to administer and provide Naloxone, and has set up Naloxone access points in underserved community areas like the Antelope Valley, North Hollywood, and Long Beach.
There are also In-custody first aid Naloxone kits available in some jail areas.
Naloxone is available in all Project RoomKey sites and County housing providers.
The Department of Health Services started (and will expand) training in harm reduction – outreach teams that serve the unhoused, services and reentry support providers and case managers, and housing sites. The DHS initiative will focus on harm reduction strategies like motivational interviewing, brief harm reduction moments.
Medication Assisted Treatment (MAT): Since 2020, DHS launched LosAngelesMAT.org, launched the MAT Consultation Line, and expanded MAT access in DHS and in the community. Jail MAT started in 2020/21 although remains far less available than it needs to be, and transitions into the community remain problematic. DHS expanded primary care MAT clinics to include Rancho Los Amigos and more ACN Sites such as Roybal and High Desert. UCLA Harbor- Medical Center also joined USC and Olive View as having an inpatient MAT consult service.
What's Needed
The County needs to significantly scale up investment to meet the need for MAT and other harm reduction services. The County must invest in a continuum of care so that providers can hire people with lived experience and support their engagement and outreach efforts.
The County needs to expand harm reduction training and the expansion needs to be a long-term commitment. For example, the County cannot start outreach for one year and then disappear.
We urgently need safe consumption sites
We urgently need mobile syringe exchange services, broader investment in fixed sites and spaces – We urgently need drug user health hubs and drop-in centers.
The County needs one centralized system for MAT coordination upon jail release.
We urgently need a dedicated MAT reentry resource. The County needs more funding for addiction medicine physicians and more funding for learning collaboratives that can continue to expand MAT into the community.
GRADE: B/C
Recommendation
What's Been Done
What's Needed
Recommendation
#20: LA County must provide adequate community-based beds for people being released from jail who need housing to stabilize.
What's Been Done
The ATI office is conducting community bed analysis but has not provided an update on its status.
ODR has expanded to include more interim housing to serve 634 people, permanent supportive housing serving 545 people. ODR required to stay below cap of 2200 beds despite huge need for more.
The County is not adequately tracking how many individuals are placed into treatment through the Rapid Diversion Program.
What's Needed
MCJ Closure Report recommended adding 4,000 community beds (3600 of which are mental health) in 18-24 months. CEO Executive Work Group recommended 10,000 in 3 years.
GRADE: F
Recommendation
What's Been Done
What's Needed
Recommendation
#59: Expand access to pre-plea mental health diversion.
What's Been Done
Law enforcement agencies and local governments, residents and businesses throughout the county are desperate for alternatives to arrest when mental health is at issue. County has implemented the ATI Pre-Filing Diversion Program & ODR LEAD (pre-filing more focused on SUD), ATI Rapid Diversion Program, but not at every courthouse (RDP 2021=473 total cases-333 diverted others pending), report more than 700 as of 3/22. The County has yet to say how many individuals who are diverted actually make it into treatment beds. Eligibility criteria is also restricted.
-ODR pre-plea beds added since 1/20 = 630
What's Needed
Immediately begin implementation of ATI report recommendations #2, 35, 37, 38 and Alternative Crisis Response, INCLUDING sufficient funding for community-based treatment resources to serve as accessible and effective alternatives to arrest and jail.
Resource ODR sufficiently to accept any client who qualifies for pre-plea mental health diversion.
Get new pretrial services office up and running within 3 months. Funding has yet to be committed by the CEO and BOS to the JCOD, pretrial agency infrastructure, and community-based services within the new department.
Evaluate RDP – if found effective at long-term stabilization and reduced re-arrest, expand throughout county to meet the need.